Martínez de Llano S R, Delgado-Bolton R C, Jiménez-Vicioso A, Pérez-Castejón M J, Carreras Delgado J L, Ramos E, Rotger A, Jiménez F, Alonso J C, Bittini A, Domínguez P, Almoguera M, Pérez-Vázquez J M
Servicio de Medicina Nuclear, Hospital Universitario Gregorio Marañón, Madrid, España.
Rev Esp Med Nucl. 2007 Jan-Feb;26(1):19-29.
Renal cell carcinoma is the most frequent solid kidney tumor. At present, PET is not the imaging test of choice, the helical CT being the best method to assess these patients. The aim of the study was to perform a meta-analysis of the literature to evaluate the performance and accuracy of 18F-FDG PET in the detection of primary disease, recurrence and metastasis of renal cell carcinoma.
A systematic search was done of the available literature in primary and secondary databases published until October 2004 indexed in MEDLINE and CANCERLIT. Exclusion/inclusion criteria were applied. Their quality was evaluated using the Flynn criteria and joint estimators of sensitivity (S), specificity (Sp), likelihood ratios (LR), diagnostic odds ratio (DOR) and summary ROC (SROC) curve were obtained. The presence of the threshold effect was evaluated and the summary ROC (SROC) curve was calculated.
Seven out of 46 studies fulfilled the inclusion criteria and were analyzed. Three studies evaluated the use of 18F-FDG PET in the differential diagnosis of renal masses. Two studies analyzed restaging and two analyzed the role of 18F-FDG PET in the detection of metastatic disease. All the selected studies were classified according to Flynn's criteria. We found the highest S in restaging with S 0.87 (95 % CI, 0.75-0.95) and in metastases detection with S 0.72 (95 % CI, 0.56-0.85) as well as the high Sp in differential diagnosis of renal masses.
The results of this meta-analysis suggest that 18F-FDG PET can be useful in restaging and detection of metastatic disease, based on its acceptable S and Sp. However, the performance of 18F-FDG PET in the detection of primary disease is limited, but this may improve with the new PET/CT systems.
肾细胞癌是最常见的肾脏实体肿瘤。目前，PET并非首选的影像学检查方法，螺旋CT是评估此类患者的最佳方法。本研究的目的是对文献进行荟萃分析，以评估18F-FDG PET在检测肾细胞癌原发疾病、复发及转移方面的性能和准确性。
对截至2004年10月发表在MEDLINE和CANCERLIT索引的一级和二级数据库中的现有文献进行系统检索。应用排除/纳入标准。采用Flynn标准评估其质量，并获得敏感性（S）、特异性（Sp）、似然比（LR）、诊断比值比（DOR）和汇总ROC（SROC）曲线的联合估计值。评估阈值效应的存在并计算汇总ROC（SROC）曲线。
46项研究中有7项符合纳入标准并进行了分析。3项研究评估了18F-FDG PET在肾肿块鉴别诊断中的应用。2项研究分析了再分期，2项研究分析了18F-FDG PET在检测转移性疾病中的作用。所有选定的研究均根据Flynn标准进行分类。我们发现再分期时敏感性最高，S为0.87（95%CI，0.75 - 0.95），检测转移时S为0.72（95%CI，0.56 - 0.85），肾肿块鉴别诊断中特异性也较高。
这项荟萃分析的结果表明，基于其可接受的敏感性和特异性，18F-FDG PET在再分期和检测转移性疾病方面可能有用。然而，18F-FDG PET在检测原发疾病方面的性能有限，但随着新的PET/CT系统可能会有所改善。
